The blood supply of the reverse temporalis muscle flap: Anatomic study andclinical implications

Although the reverse temporalis muscle flap has been used clinically, the e xact vascular connection between the superficial and deep temporal vessels has not been clearly defined. The purpose of this study was to investigate the vascular territory of the reverse temporalis muscle supplied by the sup erficial temporal vessels. Six cadaver heads were studied using a colored l ead oxide injection through the superficial temporal artery. The specimens were examined macroscopically and radiographically. The reverse temporalis muscle flap was then applied to a clinical case presenting with traumatic a nterior skull base defect communicating with the nasal cavity. The cadaver specimens demonstrated that the superficial temporal artery for med an average 1.3 +/- 0.2 cm in width of dense vascular zone, which was lo cated within 1.8 cm below the superior temporal line. The dense vascular ne twork further perfused the anterior and posterior deep temporal arteries an d the muscular branch of the middle temporal artery to supply the temporali s muscle. The mean perfused area of the temporalis muscle was 83 percent, r anging from 79 to 89 percent, in five cadaver heads. One cadaver revealed o nly 55 percent of perfused area in the absence of the muscular branch of th e middle temporal artery. The consistent area without perfusion was located in the distal third of the posterior portion of the reverse temporalis mus cle. In clinical cases, the reverse temporalis muscle flap was used success fully to obliterate the anterior skull base defect without evidence of musc le flap necrosis. The exact blood supply to the distal third of the posteri or portion of the reverse temporalis muscle flap needs to be investigated f urther in vivo. Particular attention was paid to the inclusion of the muscu lar branch of the middle temporal artery in this flap to augment the blood supply to the temporalis muscle.